| Ellie Mental Health | |
|
563 W 500 S Bountiful UT 84010-8172 | |
| (801) 726-4845 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Counselor |
| Location | 563 W 500 S, Bountiful, Utah |
| Authorized Official Name and Position | Steve M Leblanc (COO) |
| Authorized Official Contact | 8017264845 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 2028 S 875 E Clearfield UT 84015-6266 Ph: (801) 726-4845 | Ellie Mental Health 563 W 500 S Bountiful UT 84010-8172 Ph: (801) 726-4845 |
| NPI Number | 1154051167 |
|---|---|
| Provider Enumeration Date | 06/13/2022 |
| Last Update Date | 07/27/2022 |
| Certification Date | 07/27/2022 |
| Medicare PECOS PAC ID | 5395118293 |
|---|---|
| Medicare Enrollment ID | O20230223001570 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154051167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Mary Haug |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457764821 PECOS PAC ID: 8628441490 Enrollment ID: I20230224001648 |
| Provider Name | Alyson Gardner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093232324 PECOS PAC ID: 8921471723 Enrollment ID: I20230225000258 |
| Provider Name | Clancy Halsted |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043837446 PECOS PAC ID: 0840679486 Enrollment ID: I20230306000594 |
| Provider Name | Christopher Curlett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093170706 PECOS PAC ID: 7012365976 Enrollment ID: I20231204000111 |
| Provider Name | Robert Austin Bulloch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487258299 PECOS PAC ID: 4385094994 Enrollment ID: I20231222000644 |
| Provider Name | Dina Hargrave |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598157489 PECOS PAC ID: 8224480280 Enrollment ID: I20240116002115 |
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